下肢深静脉血栓发生肺栓塞的危险因素分析及Nomogram模型的构建  

Risk factors of pulmonary embolism in deep venous thrombosis of lower extremities and construction of a Nomogram model

作　　者：桂锐 周伟 王孝高[2] 高涌[2] 卢冉[2] 陈世远[2] 官泽宇[2] GUI Rui;ZHOU Wei;WANG Xiaogao;GAO Yong;LU Ran;CHEN Shiyuan;GUAN Zeyu(Department of Vascular Surgery,Allgemeines Krankenhaus der Huainan Oriental Hospital Group,Huainan,Anhui 232000,China;Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]淮南东方医院集团总院血管外科,安徽淮南232000 [2]蚌埠医学院第一附属医院血管外科,安徽蚌埠233004

出　　处：《国际检验医学杂志》2023年第23期2897-2901,共5页International Journal of Laboratory Medicine

基　　金：安徽高校自然科学研究重点项目(KJ2019A0327)。

摘　　要：目的探讨下肢深静脉血栓发生肺栓塞的危险因素,构建Nomogram预测模型。方法选取淮南东方医院集团总院在2018年1月至2022年6月收治的90例下肢深静脉血栓并发肺栓塞患者(病例组),90例下肢深静脉血栓未并发肺栓塞患者(对照组)进行分析。对患者基本资料、基础疾病、血液指标等进行分析;对差异有统计学意义的连续性变量进行受试者工作特征(ROC)曲线分析和多因素Logistic回归模型分析;将筛选出的独立危险因素建立Nomogram模型,并对此模型进行性能评价。结果病例组患者年龄、体重指数(BMI)、吸烟、心脏病、慢性阻塞性肺疾病、静脉血栓病史占比及D-二聚体、同型半胱氨酸水平与对照组比较,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,年龄、BMI、D-二聚体、同型半胱氨酸的曲线下面积(95%CI)分别为0.772(0.703~0.831)、0.724(0.652~0.787)、0.873(0.815~0.918)、0.858(0.798~0.905)。年龄>61岁、BMI>23.80 kg/m^(2)、慢性阻塞性肺疾病、D-二聚体>5.94 mg/mL、同型半胱氨酸>18.85μmol/L是下肢深静脉血栓并发肺栓塞的独立危险因素(P<0.05)。决策曲线分析结果显示,风险阈值>0.02时,此模型所提供的临床净收益较高。结论年龄>61岁、BMI>23.80 kg/m^(2)、慢性阻塞性肺疾病、D-二聚体>5.94 mg/mL、同型半胱氨酸>18.85μmol/L是下肢深静脉血栓并发肺栓塞的独立危险因素,该研究依据此独立危险因素建立的Nomogram模型预测性能良好。Objective To explore the risk factors of pulmonary embolism in patients with deep vein thrombosis of lower extremities and to construct a Nomogram model.Methods A total of 90 patients with deep vein thrombosis of lower extremity complicated with pulmonary embolism(case group)and 90 patients with deep vein thrombosis of lower extremity without pulmonary embolism(control group)admitted to Allgemeines Krankenhaus der Huainan Oriental Hospital Group from January 2018 to June 2022 were selected for analysis.The basic information,basic diseases and blood indexes of the patients were analyzed.Receiver operating characteristic(ROC)curve analysis and multivariate Logistic regression model were used to analyze the continuous variables with statistically significant differences.The independent risk factors were selected to establish a Nomogram model,and the performance of this model was evaluated.Results There were significant differences in age,body mass index(BMI),smoking,history of heart disease,chronic obstructive pulmonary disease,venous thrombosis,D-dimer and homocysteine levels between the case group and the control group(P<0.05).ROC curve analysis showed that the area under the curve(95%CI)of age,BMI,D-dimer and homocysteine were 0.772(0.703-0.831),0.724(0.652-0.787),0.873(0.815-0.918)and 0.858(0.798-0.905),respectively.Age>61 years,BMI>23.80 kg/m^(2),chronic obstructive pulmonary disease,D-dimer>5.94 mg/mL,homocysteine>18.85μmol/L were independent risk factors for deep vein thrombosis complicated with pulmonary embolism(P<0.05).Decision curve analysis showed that when the risk threshold was more than 0.02,the net clinical benefit provided by this model was higher.Conclusion Age>61 years,BMI>23.80 kg/m^(2),chronic obstructive pulmonary disease,D-dimer>5.94 mg/mL,homocysteine>18.85μmol/L are independent risk factors for deep vein thrombosis complicated with pulmonary embolism.The Nomogram model established in this study based on this independent risk factor has a good prediction performance.

关 键 词：下肢深静脉血栓 肺栓塞 危险因素 Nomogram模型 

分 类 号：R447[医药卫生—诊断学]